Tuesday October 15 1996 07:25, Gary Saffer wrote to Stephen Kirkpatrick:
 SK>> From what I've seen, it appears that regardless of what condition the
 SK>> person  is in (in the middle of a seizure or already out), by the
 SK>> time the police or  EMT's get there the person, by default, is
 SK>> brought to the nearest emergency  room.
 GS>  I have seen and/or heard many EMT's say that their policy was to do
 GS> just that. When I asked why, I was told that it was primarily to protect
 GS> themselves from litigation regardless of whether the person actually
 GS> needed  help.
    The main problem with liability (the source of our difficulty) is that we 
are neither trained nor equipped (nor allowed) to make final diagnoses.  The 
seizure activity could be a result of epilepsy - or it could be the result of 
any one or more of a variety of causes.  Since we can not definitively say 
that the cause was previously diagnosed epilepsy and that there was no 
permanent or dangerous damage done to the person (either causing or as a 
result of the seizure activity) the only thing we can do is offer 
transportation to hospital with attendant emergency care and if the patient 
is rational enough to refuse treatment / transportation, allow them to do so.
    If we are not busy, and we are concerned that the cause may have been 
other than "routine", we can spend time attempting to convince the patient to 
allow transporation to the ER.  We can alternatively call the police and have 
them take the person into their custody (either arrest them for something, or 
take them into custody under the mental health act or some other legislation) 
and then, with police escort, take them to the ER.
    If the patient is competent to decide, and refuses treatment, we can do 
nothing to help them until and unless they lose consciousness or change their 
mind.
    Personally, the issue of possible litigation against me is not the 
primary reason why I would transport a patient (although it is something that 
is, as the song says 'always on my mind...'), rather I would do it out of 
concern that there may be some (to me, in the field) undetectable and 
potentially fatal or incapacitating injury to the person.
 GS> As a rule, unless the person can prove themselves oriented and competent
 GS> to make a decision to refuse transport, they will be transported to an
 GS> emergency department for treatment.
    Definately.  The confusion could be the after effects of the seizure or 
it could be due to shock, head injury, drug reaction, diabetic crisis,.... ad 
nauseum.  Altered level of consciousness is, by itself, considered life 
threatening until proven otherwise.
 GS> People who have had seizures will be
 GS> confused for a length of time afterwards and may not be able to make a
 GS> rational decision.
    They'll also be tired, and usually want to sleep.  If they aren't able to 
stay awake we have no way of determining that a serious emergency is not the 
problem.  Transporting the patient is not only a CYA manoever, it is also CPA 
(Cover Patient's A**).
 GS> If the cause of the seizure is something other than
 GS> epilepsy, then they SHOULD be transported for evaluation and treatment.
    Absolutely.
    I once had a patient seizure (intermittently, 90 seconds of seizure 
followed by 5-10 seconds of non-seizure) for 45 minutes until the ambulance 
arrived (I was providing first aid coverage to a campground in rural Quebec), 
the pattern continued all the way to hospital (about 1 hour - 1:15 transport 
time).  The patient was conscious the whole time, asking me to do something 
to stop the seizures.  Since I was (and am) not equipped or trained in the 
use of that type of medication, there was nothing I could do.  The ambulance 
was BLS, so there was not much they could do either.
    It turned out that the cause of this activity was a combination of some 
fad dieting, use of stimulants (primarily caffeine) to stay up all the time, 
and lack of sleep.
    How I could have diagnosed that in the field I don't know.
Chris
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